END - Pedia

Question 1

Hemorrhagic disease of the newborn (HDN) is prevented by administration of a single dose of vitamin K (1 mg).
a. Oral
b. Intravenous
c. Subcutaneous
d. Intramuscular

Answer 1

d. Intramuscular
- Rationale: Hemorrhagic disease of the newborn is prevented by administering vitamin K prophylactically. The recommended route is intramuscular, which ensures effective absorption and immediate utilization by the body to prevent bleeding.

Question 2

Very low birth weight (VLBW) infants, defined as infants having birth weights of less than:
a. 750 gm
b. 1000 gm
c. 1500 gm
d. 2000 gm
e. 2500 gm

Answer 2

b. 1000 gm

Question 3

All the following are problems of small for gestational age infants except:
a. Anemia
b. Hypothermia
c. Hypoglycemia
d. Perinatal asphyxia

Answer 3

d. Perinatal asphyxia
- Rationale: Small for gestational age (SGA) infants commonly face problems like hypoglycemia, hypothermia, and anemia due to their size and intrauterine conditions, but perinatal asphyxia is not specifically associated with being small for gestational age.

Question 4

Which of the following statements best describes milia?
a. These are numerous small areas of red skin with a yellow papule in the center.
b. These are erythematous plaques with sharply demarcated edges.
c. These are whitish pin-head size concretions usually seen on the chin, nose, forehead, and cheeks.
d. These are comedones and papules usually seen over the cheeks, chin, and forehead.

Answer 4

c. These are whitish pin-head size concretions usually seen on the chin, nose, forehead, and cheeks.
- Rationale: Milia are tiny cysts filled with keratin that appear as small white bumps on the face of newborns. They are common and benign, typically resolving without treatment.

Question 5

The findings used to estimate the gestational age based on physical maturity by the New Ballard scoring system are a description of the following except:
a. Lanugo
b. Skin texture
c. Genitalia
d. Palmar creases
e. Ear cartilage

Answer 5

d. Palmar creases
- Rationale: The New Ballard Score includes an assessment of physical maturity features like lanugo, skin texture, genitalia, and ear cartilage firmness to estimate gestational age, but it does not use palmar creases as a criterion.

Question 6

Characteristic respiratory patterns in normal newborns include all of the following except:
a. Breath sounds are bronchovesicular
b. Periodic breathing predominates
c. Occasional apneic episodes in moderately premature infants
d. Grunting and nasal flaring

Answer 6

d. Grunting and nasal flaring
- Rationale: Normal newborn respiratory patterns can include bronchovesicular breath sounds and periodic breathing. Occasional apneic episodes might occur in moderately premature infants. However, grunting and nasal flaring are signs of respiratory distress and not normal respiratory patterns.

Question 7

True statements about postmaturity include each of the following, except:
a. The infants are usually 42-44 weeks
b. The fingernails and umbilical cord may be yellow-stained
c. There is an increased incidence of fetal distress, meconium aspiration
d. Birth weight is usually greater than the 95th percentile

Answer 7

d. Birth weight is usually greater than the 95th percentile
- Rationale: Postmature infants, those born after 42 weeks of gestation, often face issues like fetal distress and meconium aspiration. They can also show physical signs of postmaturity such as peeling skin and long nails, but they are often underweight or have weights that fall within normal ranges rather than being significantly large.

Question 8

Rooming in refers to the procedure of nursing babies with their mother rather than keeping them in a separate nursery. The advantages include all of the following except:
a. Promotes bonding
b. Makes exclusive breastfeeding easy
c. Increases the risk of infection
d. Mother is able to keep a close watch on her infant

Answer 8

c. Increases the risk of infection
- Rationale: Rooming-in has several
advantages, such as promoting bonding and facilitating breastfeeding, and it helps in monitoring the infant closely. It does not increase the risk of infection; in fact, it may decrease exposure to nosocomial infections compared to traditional nursery care.

Question 9

Good cord care includes all of the following except:
a. Cutting the cord with sterile equipment or a new razor blade depending on the setting
b. Ligation with a sterile plastic clamp or clear thread
c. Binding, use of powder on the cord
d. Keeping the cord stump exposed, cleaning with 70% alcohol or simple soap and water

Answer 9

c. Binding, use of powder on the cord
- Rationale: Proper cord care includes keeping the cord stump clean and dry, using sterile equipment for cutting and clamping, and avoiding practices like binding or using powders, which can increase the risk of infection.

Question 10

Premature babies are prone to hypothermia because of:
a. Subcutaneous fat is thinner
b. Small body surface area
c. Adequate brown fat
d. Capable of shivering thermogenesis

Answer 10

a. Subcutaneous fat is thinner
- Rationale: Premature babies are particularly susceptible to hypothermia due to having thinner layers of subcutaneous fat, which provides less insulation. They also have a larger body surface area relative to their weight but lack adequate brown fat for non-shivering thermogenesis, making temperature regulation more challenging.

Question 11

Jaundice is most likely to be physiologic in a term infant in which one of the following situations?
a. Jaundice within 24 hours of life
b. Bilirubin increasing < 1mg/dL/24 hours in the first 2 days
c. Direct serum bilirubin level > 15% of the total bilirubin level
d. Jaundice after the second week of life

Answer 11

b. Bilirubin increasing < 1mg/dL/24 hours in the first 2 days
- Rationale: Physiologic jaundice in term infants typically presents after the first 24 hours of life and involves a gradual rise in bilirubin levels, less than 5 mg/dL/day, peaking around the third to fifth day and declining thereafter. Jaundice within the first 24 hours, or direct bilirubin levels greater than 15% of total bilirubin, typically suggests pathologic jaundice.

Question 12

In asymmetric IUGR, which organ is not affected?
a. Subcutaneous fat
b. Muscle
c. Liver
d. Brain

Answer 12

d. Brain
- Rationale: In asymmetric (or “brain-sparing”) intrauterine growth restriction (IUGR), the adaptation of the fetus involves preservation of blood flow to essential organs like the brain, at the expense of other organs like the liver, muscles, and subcutaneous fat tissues.

Question 13

Whitish shiny cysts that are found in the palate and gum margins of newborns are:
a. Epstein pearls
b. Herpes simplex
c. Milia
d. Erythema toxicum

Answer 13

a. Epstein pearls
- Rationale: Epstein pearls are small, white cystic lesions found along the gums and at the junction of the hard and soft palates. They are common and benign, consisting of trapped epithelial cells.

Question 14

Normal caloric requirement (kg/day) of a term newborn infant in the first 7-10 days:
a. 110-120 kcal
b. 120-150 kcal
c. 90-100 kcal
d. 150-200 kcal

Answer 14

a. 110-120 kcal

Question 15

A child can roll in both directions, sits still, reaches one hand, and babbles. Developmental age of this child:
a. 2 months
b. 4 months
c. 6 months
d. 9 months

Answer 15

c. 6 months
- Rationale: By six months, infants typically can roll over in both directions, sit with support, reach with one hand, and start babbling, indicating normal developmental progress for this age.

Question 16

A central issue during the early school years:
a. Acceptance
b. Independence
c. Rapprochement
d. Self-esteem

Answer 16

d. Self-esteem.
During the early school years, children are developing a sense of self-esteem and competence through social interactions and academic achievements.

Question 17

Difficulty in following directions, wandering attention during lessons, and difficulty with reading comprehension are associated problems of this process:
a. Expressive language
b. Receptive language
c. Short-term memory
d. Selective attention

Answer 17

b. Receptive language
- Rationale: Problems with following directions, wandering attention, and difficulty with reading comprehension are typically associated with issues in receptive language, which involves the ability to understand and process spoken and written language.

Question 18

The earliest sign of puberty among boys:
a. Enlargement of the penis
b. Change in the texture of the scrotum
c. Enlargement of the testicles
d. Appearance of pubic hair

Answer 18

c. Enlargement of the testicles
- Rationale: The earliest sign of puberty in boys is typically the enlargement of the testicles, followed by other changes such as the enlargement of the penis, the appearance of pubic hair, and changes in scrotal texture.

Question 19

The first visible sign of puberty among girls:
a. Appearance of fine straight pubic hair
b. Widening of the hips
c. Enlargement of the labia majora
d. Appearance of breast bud

Answer 19

. d. Appearance of breast bud
- Rationale: The first visible sign of puberty in girls is the appearance of the breast bud, known as thelarche, which precedes other pubertal developments such as pubic hair growth.

Question 20

The sequence of development of secondary sexual characteristics in girls includes:
a. Thelarche, pubarche, peak height velocity, menarche
b. Pubarche, thelarche, menarche, peak height velocity
c. Menarche, pubarche, peak height velocity, thelarche
d. Peak height velocity, thelarche, menarche, pubarche

Answer 20

a. Thelarche, pubarche, peak height velocity, menarche
- Rationale: The typical sequence of development of secondary sexual characteristics in girls starts with thelarche (breast development), followed by pubarche (pubic hair development), peak height velocity (growth spurt), and finally menarche (onset of menstruation).

Question 21

If Sonia’s SMR is stage IV, what is her expected breast finding should be?
a. Areola is part of the general breast contour.
b. Areola and papilla form a secondary mound.
c. Breast and papilla are elevated as a small mound with an increased areola diameter.
d. Breast and areola are enlarged but with no contour separation.

Answer 21

b. Areola and papilla form a secondary mound.
- Rationale: In SMR (Sexual Maturity Rating) stage IV for breast development, the areola and papilla rise above the level of the breast to form a secondary mound distinct from the contour of the rest of the breast.

Question 22

The Tanner Stage of Ralph, who has pubic hair that is thicker, curlier, spread to the mons pubis, penis lengthens, and larger testes:
a. SMR 2
b. SMR 3
c. SMR 4
d. SMR 5

Answer 22

b. SMR 3

Question 23

Spermache, appearance of acne, and axillary perspiration among boys usually occur during this period:
a. SMR 2
b. SMR 3
c. SMR 4
d. SMR 5

Answer 23

c. SMR 4
- Rationale: Spermarche, the appearance of acne, and increased axillary perspiration typically occur during SMR stage 4, reflecting further advancement in pubertal development.

Question 24

Characteristics of cognitive development during early adolescence:
a. Transition from concrete operational thinking to formal logical operation
b. Extensive questioning and analysis
c. Increasing thoughts about concepts of justice, patriotism, and history
d. Cognition tends to be less self-centered

Answer 24

a. Transition from concrete operational thinking to formal logical operation
- Rationale: Early adolescence is marked by the cognitive transition from concrete operational thinking, where children are focused on tangible, present objects, to formal logical operations, where they can consider abstract concepts and hypothetical situations.

Question 25

Regarding breath-holding spells in children, one of the following statements is NOT true:
a. It is fairly common in the first 2 years of life
b. It does not contribute to an increased risk of seizure disorders
c. Parents are advised to ignore and not to reinforce these attacks
d. It must be immediately attended to prevent hypoxia and onset of seizures

Answer 25

d. It must be immediately attended to prevent hypoxia and onset of seizures
- Rationale: Breath-holding spells are self-limiting events that do not usually lead to hypoxia or seizures, and they do not increase the risk of developing seizure disorders. Parents are generally advised to not overly react to these episodes to avoid reinforcing the behavior.

Question 26

Head control is possible in an infant by ____ months of age.
a. 1
b. 2
c. 3
d. 6

Answer 26

c. 3
- Rationale: By around 3 months of age, infants typically develop sufficient neck muscle strength to control their head movements.

Question 27

A one-month-old infant can do all of the following, EXCEPT:
a. Tonic neck posture predominates in supine
b. Follows a moving object
c. Head lag on pull to a sitting position
d. Listen to voices, coos

Answer 27

d. Listen to voices, coos.
At one month, infants typically exhibit a head lag when pulled to a sitting position, can have tonic neck reflex, and may begin to follow moving objects with their eyes, but consistently cooing is generally expected around the second month.

Question 28

Which of the following acts can a one-year-old perform?
a. Drinks from a cup
b. Speaks one or two words with meaning
c. Rings a bell purposely
d. Sits down from a standing position

Answer 28

b. Speaks one or two words with meaning.
Most one-year-olds can speak one or two words with meaning, like “mama” or “dada,” which are among the milestones for this age.

Question 29

Birth weight of an infant usually doubles at:
a. 6 months of age
b. 1 year of age
c. 2 years of age
d. 3 years of age

Answer 29

a. 6 months of age
Rationale: Typically, an infant’s birth weight doubles by the age of 6 months.

Question 30

Which comes first in an infant?
a. Social smile
b. Stranger anxiety
c. Sitting without support
d. Pincer grasp

Answer 30

a. Social smile
Rationale: Social smiling usually appears around 6 weeks of age and is one of the first social behaviors to develop. This milestone comes before others such as stranger anxiety, sitting without support, and the pincer grasp, which develop later in infancy.

Question 31

A normal infant sits briefly leaning forward on her hands, reaches for and grasps a cube, and transfers it from hand to hand. She babbles but cannot wave bye-bye nor can she grasp objects with the thumb and finger:
a. 4 months
b. 7 months
c. 10 months
d. 14 months

Answer 31

b. 7 months
Rationale: By 7 months, infants can sit briefly leaning on their hands, reach and grasp objects like a cube, and transfer objects from hand to hand. They also begin babbling around this age, but more precise finger skills like waving bye-bye and the pincer grasp typically develop later.

Question 32

A child who sits unsupported by own hands and who pulls to standing position, waves bye-bye, or plays peek-a-boo:
a. 4 months
b. 6 months
c. 8 months
d. 10 months

Answer 32

d. 10 months

You asked about a child who can sit unsupported, pulls to a standing position, and either waves bye-bye or plays peek-a-boo. Looking at the milestones:

Sitting unsupported: Mentioned specifically as “Sits momentarily” at 6 months.
Pulls to stand: Occurs at 9 months.
Waves bye-bye or plays peek-a-boo: Both are social skills; “Plays pat-a-cake, peek-a-boo” falls under the 9 months category.

Question 33

A child who is able to discriminate the use of “Mama” or “Dada”, stands alone, imitates action has reached a developmental age at:
a. 36 months
b. 24 months
c. 12 months
d. 6 months

Answer 33

c. 12 months
Rationale: By 12 months, children start using specific words like “Mama” or “Dada” more discriminately, can stand alone, and begin to imitate actions, marking significant cognitive and motor development.

Question 34

The following are normal findings in children:
a. Standing unaided at 13 months
b. The first molar erupting at 6 months
c. Extensor plantar response at age 26 months
d. Controls bowels by age 13 months

Answer 34

a. Standing unaided at 13 months
Rationale: It’s normal for children to start standing unaided around 13 months. The other options listed are not typical developmental milestones for their respective ages.

Question 35

A 16-year-old female who is pregnant complains of headaches and has blurring of the disc margin on fundoscopy. Which of the following cranial nerves is affected?
a. Optic nerve
b. Oculomotor nerve
c. Trigeminal nerve
d. Abducens nerve

Answer 35

a. Optic nerve
Rationale: Blurring of the disc margin on fundoscopy suggests an issue with the optic nerve, which is responsible for vision.

Question 36

If a patient comes in and you ask him to stick out his tongue and it deviates to the left, which cranial nerve could be involved and what side?
a. CN XI, left
b. CN XII, left
c. CN XI, right
d. CN XII, right

Answer 36

b. CN XII, left
Rationale: The hypoglossal nerve (Cranial Nerve XII) controls the muscles of the tongue. If the tongue deviates to one side when stuck out, it indicates a lesion in the hypoglossal nerve on the same side as the deviation.

Question 37

Two carpal bones are radiologically seen in the X-ray of most children by the end of:
a. 1 year
b. 2 years
c. 3 years
d. 4 years

Answer 37

b. 2 years
Rationale: By the end of 2 years, radiologically visible ossification in the wrist allows for the detection of two carpal bones on X-ray in most children.

Question 38

Which among the following is NOT expected in a 3-year-old?
a. Draw a circle
b. Talk in sentences
c. Climb down the stairs
d. Hop 5 steps

Answer 38

d. Hop 5 steps
Rationale: Hopping 5 steps requires more advanced motor skills typically not developed in 3-year-olds. Other listed abilities like drawing a circle, talking in sentences, and climbing down stairs are appropriate expectations for this age.

Question 39

A newborn baby has a head circumference of 35 cm at birth. His optimal head circumference will be 43 cm at:
a. 4 months of age
b. 6 months of age
c. 8 months of age
d. 12 months of age

Answer 39

d. 12 months of age

Question 40

The normal caloric requirement for a 5-year-old child is:
a. 800 kcal/day
b. 1,000 kcal/day
c. 1,500 kcal/day
d. 2,000 kcal/day

Answer 40

c. 1,500 kcal/day
Rationale: The average caloric requirement for a 5-year-old is approximately 1,500 kcal/day, depending on their level of activity and metabolic demands.

Question 41

One of the following statements is TRUE of Ascorbic Acid?
a. It is stable in the presence of light, alkaline medium, and heat
b. It decreases the absorption of iron
c. Its supplementation effectively decreases the incidence of scurvy
d. Its requirement is increased during febrile episodes

Answer 41

c. Its supplementation effectively decreases the incidence of scurvy
Rationale: Ascorbic acid (Vitamin C) is essential for the prevention and treatment of scurvy, which is caused by a deficiency of vitamin C. Supplementation with vitamin C effectively prevents and treats this condition.

Question 42

Infants exclusively breastfed for six months will have:
a. More episodes of diarrhea and URTI
b. Fewer episodes of allergic manifestations
c. The same weight gain as formula-fed infants
d. More episodes of colic

Answer 42

b. Fewer episodes of allergic manifestations
Rationale: Infants who are exclusively breastfed for six months tend to have fewer allergic reactions compared to those who are formula-fed, likely due to immune protective factors in human milk.

Question 43

What component in human milk provides specific immunity against many organisms?
a. Lactoferrin
b. Macrophages
c. Oligosaccharides
d. Secretory IgA

Answer 43

d. Secretory IgA
Rationale: Secretory IgA in human milk provides specific immunity by protecting the infant against pathogens by binding to them and preventing their attachment and invasion of mucosal surfaces.

Question 44

One of the anthropometric indications that is unaffected by excess fat or fluid is:
a. Head circumference
b. Weight
c. Height
d. Mid-upper arm circumference

Answer 44

c. Height

Question 45

The most common cause of poor weight gain among breastfed infants during the first 4 weeks after birth is:
a. Infant metabolic disorders
b. Low-fat content of breast milk
c. Maternal nutritional deficiencies
d. Infrequent or ineffective feedings

Answer 45

d. Infrequent or ineffective feedings
Rationale: The most common cause of poor weight gain in breastfed infants, particularly in the first few weeks, is often due to infrequent or ineffective breastfeeding, which results in inadequate milk intake.

Question 46

Which one of the following contains the least fat content in the milk?
a. Carabao milk
b. Cow milk
c. Goat milk
d. Human milk

Answer 46

d. Human milk
Rationale: Compared to other types of milk mentioned, human milk generally contains less fat content, adapted to the specific nutritional needs of human infants.

Question 47

A 4-day-old newborn while being managed for neonatal sepsis suddenly went into cardiopulmonary arrest. Chest compression technique applied:
a. Compression to ventilation ratio 10:1
b. Heel of one hand is used
c. 2 fingers technique positioned 1 finger breadth below the intermammary line
d. Depth of compression is 2 inches

Answer 47

c. 2 fingers technique positioned 1 finger breadth below the intermammary line
Rationale: For newborns, the recommended technique for chest compressions during cardiopulmonary resuscitation (CPR) is using two fingers placed about one finger breadth below the nipple line (intermammary line).

Question 48

John, a 2-year-old boy, cried the whole night pulling his ear. Otoscopy done:
a. To evaluate the auditory canal
b. Right hand holds otoscope to examine the left ear
c. Pinna is pulled posteriorly and downward
d. 4mm speculum is used

Answer 48

c. Pinna is pulled posteriorly and downward

Question 49

A 2-year-old girl came in at the ER with PR-10/min., CR-55/min., and is limp. ET intubation done and it is in place if:
a. Equal wheezing in each lateral chest
b. Asymmetrical chest movement
c. Presence of breath sounds in the stomach
d. Presence of condensation in the ET during exhalation

Answer 49

d. Presence of condensation in the ET during exhalation
Rationale: The presence of condensation in the endotracheal tube (ET) during exhalation is a sign that the tube is in the trachea and that there is airflow through the tube, confirming proper placement.

Question 50

Tuberculin Skin Test (PPD) done to determine if the patient is TB infected is performed at:
a. Deltoid area
b. Dorsal aspect of the hand
c. Gluteal area
d. Volar aspect of the forearm

Answer 50

d. Volar aspect of the forearm
Rationale: The Tuberculin Skin Test (PPD test) is traditionally administered intradermally on the volar aspect of the forearm. This location allows for easy observation of any reaction that may develop at the site of injection.

Question 51

The best site of intraosseous infusion for a 5-year-old boy is:
a. Proximal tibia
b. Distal femur
c. Sternum
d. Iliac crest

Answer 51

a. Proximal tibia
Rationale: The proximal tibia is the preferred site for intraosseous infusion in children due to its accessibility and the relatively large marrow cavity, which facilitates rapid absorption of infused fluids and medications.

Question 52

All of the following are vaccines that provide passive immunity to infants and children, except:
a. Diphtheria antitoxin
b. Gamma globulin
c. Giving tetanus toxoid
d. Giving tetanus immune globulin

Answer 52

c. Giving tetanus toxoid
Rationale: Tetanus toxoid is a vaccine that provides active immunity by stimulating the body to produce its own antibodies, whereas diphtheria antitoxin, gamma globulin, and tetanus immune globulin provide passive immunity by supplying pre-formed antibodies.

Question 53

A 4-day-old baby has 26 mg/dl of B1 with ABO incompatibility. The appropriate site for exchange transfusion is at:
a. External jugular vein
b. Cut-down site
c. Umbilicus
d. Intraosseous

Answer 53

c. Umbilicus
Rationale: In neonates, especially in the first week of life, the umbilical vein can be used as an access site for exchange transfusion, as it is easily accessible and can accommodate the exchange of large volumes of blood.

Question 54

Permanent hearing loss or ototoxicity is most usually associated with administration of:
a. Ethacrynic acid
b. Gentamicin
c. Thiazides
d. Mannitol

Answer 54

b. Gentamicin
Rationale: Gentamicin, an aminoglycoside antibiotic, is associated with ototoxicity, potentially causing permanent hearing loss, especially when used in high doses or for prolonged periods.

Question 55

Which of the following drugs can be administered through the rectum because of its rapid absorption and can be used to treat status epilepticus?
a. Diazepam
b. Phenobarbital
c. Phenytoin
d. Valproic acid

Answer 55

a. Diazepam
Rationale: Diazepam can be administered rectally and is effective in the rapid control of acute seizure episodes such as those seen in status epilepticus due to its fast absorption and quick onset of action.

Question 56

The following drug should be avoided in children with liver disease who are jaundiced.
a. Hydrochlorothiazide
b. Metronidazole
c. Indomethacin
d. Salbutamol

Answer 56

b. Metronidazole
Rationale: Metronidazole should be used with caution or avoided in patients with liver disease and jaundice because it is metabolized in the liver and can exacerbate liver dysfunction.

Question 57

The following properties of a drug encourage their presence in breast milk EXCEPT:
a. High lipid solubility
b. Short half-life
c. Low molecular weight
d. Unionized state

Answer 57

d. Short half-life
Rationale: A short half-life would mean the drug is cleared more rapidly from the body, so it’s less likely to be present in breast milk. The other properties listed would tend to increase a drug’s concentration in breast milk.

Question 58

Physical examination of a newborn female infant reveals meningomyelocoele, cleft lip, and craniofacial anomalies. The most likely prenatal experience to explain these findings is:
a. Alcohol
b. Lithium
c. Thiazides
d. Valproic acid

Answer 58

d. Valproic acid

Question 59

In neonates relative to adults with regards to handling of drugs which of the following is NOT true?:
a. Gastric acid is reduced
b. Fat content is low
c. Plasma albumin is low
d. The blood-brain barrier is less permeable

Answer 59

d. The blood-brain barrier is less permeable
Rationale: In neonates, the blood-brain barrier is more permeable compared to adults, which makes them more vulnerable to substances that can affect the central nervous system.

Question 60

A 2500-gram infant who is born at 36 weeks AOG has a head circumference of 27 cm and crown-heel length of 40 cm. Other findings include an upturned nose, hypotonia, hypoplastic philtrum. The most likely prenatal agent that would explain these findings is:
a. Alcohol
b. Cocaine
c. Marijuana
d. Opiate

Answer 60

a. Alcohol
Rationale: The symptoms described for the infant, including an upturned nose, hypotonia, and a hypoplastic philtrum, are characteristic of fetal alcohol syndrome, which results from prenatal alcohol exposure.

Question 61

The target organ for the teratogenic effect of Tetracyclines:
a. Ear
b. Teeth and bones
c. Kidney
d. Central nervous system

Answer 61

b. Teeth and bones
Rationale: Tetracyclines are known to bind to calcium, leading to yellow-brown discoloration of teeth and potential defects in bone growth. These effects are especially concerning in developing fetuses and young children.

Question 62

The target organ for the teratogenic effect of folic acid deficiency is:
a. Spinal cord and bones
b. Vestibular nerves
c. Kidney
d. Eyes

Answer 62

a. Spinal cord and bones
Rationale: Folic acid deficiency during pregnancy is linked to neural tube defects, which primarily affect the spinal cord. It’s crucial for preventing conditions such as spina bifida.

Question 63

The following are believed safe in pregnancy:
a. Fluoroquinolones
b. Erythromycin
c. Aminoglycosides
d. Ribavirin

Answer 63

b. Erythromycin
Rationale: Erythromycin is generally considered safe during pregnancy among the options listed. Fluoroquinolones, aminoglycosides, and ribavirin have potential risks or are contraindicated during pregnancy.

Question 64

During pregnancy which of the following statements is incorrect?:
a. Plasma volume increases
b. Blood volume increases
c. Gastric emptying time and small intestinal motility are increased
d. Predominantly water-soluble drugs will have a larger apparent volume of distribution

Answer 64

c. Gastric emptying time and small intestinal motility are increased
Rationale: During pregnancy, gastric emptying time and small intestinal motility are actually decreased, not increased, due to the effects of progesterone and mechanical pressure from the enlarging uterus.

Question 65

Anthropometric measurement which does not show much change in 1-4 years.
a. Mid arm circumference
b. Skinfold thickness
c. Height
d. Chest circumference: Head circumference ratio

Answer 65

a. Mid arm circumference.
Mid arm circumference does not change significantly between ages 1 and 4 years compared to other measurements like height, which increases as a child grows.

Question 66

Which of the following agents has an inhibitory effect on hepatic drug metabolism?
a. Erythromycin
b. Rifampicin
c. Phenobarbital
d. Phenytoin

Answer 66

a. Erythromycin
Rationale: Erythromycin is known to have an inhibitory effect on hepatic drug metabolism, particularly by inhibiting the cytochrome P450 enzyme system, which can lead to increased levels of other drugs metabolized by this pathway.

Question 67

A child can roll in both directions, sits still, reaches one hand, and babbles. Developmental age of this child:
a. 2 months
b. 4 months
c. 6 months
d. 8 months

Answer 67

c. 6 months
Rationale: The developmental milestones described—rolling in both directions, sitting with support, reaching with one hand, and babbling—are typical for a 6-month-old infant.

Question 68

The first visible sign of puberty in girls is the hallmark of:
a. SMR1
b. SMR2
c. SMR3
d. SMR4

Answer 68

b. SMR2
Rationale: The first visible sign of puberty in girls, which is the appearance of breast buds (thelarche), marks the beginning of Tanner Stage 2 (SMR2).

Question 69

By years all milk teeth are erupted:
a. 1.5 years
b. 2 years
c. 2.5 years
d. 3 years

Answer 69

d. 3 years
Rationale: By the age of 3 years, all primary teeth, commonly known as milk teeth, are typically erupted in a child.

Question 70

Robert is a 16-year-old middle adolescent who was observed to be always out with his friends, experiencing storm, stress, and relationship with parents becomes strained and distant:
a. Developing identity and self-image
b. Stereotypical behavior
c. Bids for autonomy
d. Intimate procedure takes precedence

Answer 70

c. Bids for autonomy
Rationale: The behaviors described for Robert, such as spending more time with peers and experiencing strained relationships with parents, reflect typical adolescent bids for autonomy as they seek to establish their own identity and independence from parental authority.

Question 71

Gender identity refers to a person’s basic sense of being boy/man, girl/woman, or other gender which is typically fixed by:
a. 2-3 y/o
b. 4-6 y/o
c. 7-9 y/o
d. 10-12 y/o

Answer 71

b. 4-6 y/o.
By ages 4-6, most children have a stable sense of their gender identity, understanding themselves as a boy or a girl.

Question 72

Jose had undergone the “coming out” stage of his transgender identity. Health providers can’t assist him and his family in alleviating distress and stigma reduction as early as Tanner stage:
a. I
b. II
c. III
d. IV

Answer 72

c. III

Question 73

Menarche is achieved by 90% of girls by:
a. SMR 1
b. SMR 2
c. SMR 3
d. SMR 4

Answer 73

d. SMR 4
Rationale: By Tanner stage 4 (SMR 4), approximately 90% of girls have achieved menarche. This stage is characterized by further development of secondary sexual characteristics.

Question 74

Which is incorrect about thumb sucking?
a. Can lead to malocclusion
b. Is a source of pleasure
c. Is a sign of insecurity
d. Must be treated vigorously in the first year

Answer 74

d. Must be treated vigorously in the first year
Rationale: Thumb sucking in the first year is generally considered normal and is not typically treated vigorously unless it persists beyond this age, as it can lead to issues like malocclusion if continued into older childhood.

Question 75

Psychological development during the late adolescence period:
a. Selection of adults outside the family as role models.
b. Career decision becomes pressing.
c. Physical attractiveness and popularity remain critical in peer relationships and self-esteem.
d. The presence or absence of a realistic role model can be crucial.

Answer 75

b. Career decision becomes pressing.
Rationale: During late adolescence, making decisions about a future career becomes a critical developmental task, along with more mature psychological and emotional development tasks such as defining one’s identity and values.

Question 76

The somatic changes in a male adolescent’s male secondary sex characteristics are all due to testosterone, which include all of the following except:
a. Muscular growth
b. Enlargement and pigmentation of scrotum
c. Deepening of the voice
d. Increase in body fat

Answer 76

d. Increase in body fat
Rationale: Testosterone primarily promotes muscle growth, deepening of the voice, and changes in the male reproductive system such as enlargement and pigmentation of the scrotum. It does not typically lead to an increase in body fat; this is more influenced by estrogen.

Question 77

How much potassium content is in D5IMB (Balanced Multiple Maintenance Solution)?
a. 4 mEq/L
b. 10 mEq/L
c. 20 mEq/L
d. 30 mEq/L

Answer 77

c. 20 mEq/L

Question 78

Which is an early symptom seen in extracellular fluid deficit?
a. Thirst
b. Absence of tears
c. Sunken eyes
d. Prolonged capillary refill time

Answer 78

a. Thirst
Rationale: Thirst is an early symptom of extracellular fluid deficit. As the body senses dehydration, it triggers the thirst mechanism as an initial response to encourage fluid intake.

Question 79

A 2-year-old boy was found to be alert, thirsty, with dry oral mucosa. The appropriate management is?
a. Oral rehydration
b. Intravenous fluid therapy
c. Oral rehydration and antibiotics
d. Intravenous fluid therapy and antibiotics

Answer 79

a. Oral rehydration
Rationale: For a 2-year-old boy who is alert and presenting with symptoms of mild dehydration such as thirst and dry oral mucosa, oral rehydration is appropriate and effective. Intravenous therapy or antibiotics are usually reserved for more severe cases or when oral rehydration is not possible.

Question 80

Based on the Holliday-Segar method, the maintenance fluid requirement of a 10-kg infant is approximately:
a. 1000 mL/day
b. 1200 mL/day
c. 1250 mL/day
d. 1300 mL/day

Answer 80

a. 1000 mL/day
Rationale: According to the Holliday-Segar method, the maintenance fluid requirement for a 10-kg infant is 100 mL/kg/day for the first 10 kg of body weight, which would total 1000 mL/day.

Question 81

The principal intravascular anion and the principal anion in the gastric juice is:
a. Chloride
b. Bicarbonate
c. Phosphates
d. Organic acid

Answer 81

a. Chloride
Rationale: Chloride is the principal intravascular anion and is also the main anion found in gastric juice, where it forms hydrochloric acid (HCl).

Question 82

Which is incorrect with regard to the IVF and its content?
a. Normal saline - 154 mmol Na+/L
b. LRS - 134 mmol Na+/L
c. D5W - 50 grams glucose/L
d. D5 0.3 NaCl - 77 mmol Na+/L

Answer 82

d. D5 0.3 NaCl - 77 mmol Na+/L

IVF basically comes as percentage of NSS:
○ 0.9% NSS contains 0.9 grams of NaCl/100 cc = 154 mEq of Na/L
○ 0.45% NaCl = 77 mEq of Na/L
○ 0.3% NaCl = 51 mEq of Na/L
○ 0.18% NaCl = 28 mEq of Na/L

Question 83

What is the earliest sign of hyperkalemia?
a. Sine wave
b. Peaked T wave
c. Flattened P wave
d. QRS widening

Answer 83

b. Peaked T wave
Rationale: Peaked T waves are an early electrocardiographic sign of hyperkalemia, reflecting the effect of increased potassium levels on cardiac myocyte membrane potentials.

Question 84

A rise in the pH by 0.1 causes a decrease in serum K+.
a. 0.1 mEq/L
b. 0.25 mEq/L
c. 0.5 mEq/L
d. 1.0 mEq/L

Answer 84

c. 0.5 mEq/L
Rationale: A rise in pH (indicating alkalosis) can cause a decrease in serum potassium levels due to potassium moving into cells in exchange for hydrogen ions. Typically, an increase in pH by 0.1 unit can lead to a decrease in serum potassium by approximately 0.5 mEq/L.

Question 85

A 5-year-old child with small bowel obstruction has had an NG tube placed draining yellowish gastric fluid. What acid-base disorder should be monitored in this child’s condition?
a. Respiratory alkalosis
b. Metabolic alkalosis
c. Metabolic acidosis
d. Respiratory acidosis

Answer 85

b. Metabolic alkalosis

Rationale: In cases of small bowel obstruction where a nasogastric (NG) tube is placed and is draining gastric fluid, the primary concern is metabolic alkalosis. This occurs because the gastric fluid contains a significant amount of hydrochloric acid (HCl). When this acid is removed from the body extensively through NG tube drainage, it results in a relative increase in the body’s bicarbonate levels because there is less hydrogen ion concentration to balance it. This reduction in gastric acid leads to an alkaline state in the blood. Monitoring and managing the electrolyte balance and acid-base status in such cases are crucial for the appropriate treatment of the child.

Question 86

With regards to Calcium which statement is incorrect?
a. The normal serum concentration range is 8-10.5 mg/dL
b. The ionized calcium correct range is 1.14 - 1.3 mmol/L
c. Treatment with calcium may not work if magnesium is not given as well
d. Calcium chloride has less elemental calcium than calcium gluconate

Answer 86

d. Calcium chloride has less elemental calcium than calcium gluconate
Rationale: This statement is incorrect. Calcium chloride actually contains more elemental calcium per unit mass compared to calcium gluconate, making it a more potent source of calcium.

Question 87

Which is the best statement regarding the use of combined diphtheria-tetanus-pertussis (DPT) vaccine for primary immunization of young children?
a. Is advisable only for catch-up immunization of children behind the recommended schedule
b. Is acceptable practice, although clearly inferior to the use of separate vaccines
c. Is the procedure of choice for immunization of normal children
d. Should be restricted to underdeveloped countries

Answer 87

c. Is the procedure of choice for immunization of normal children
Rationale: The combined DTP (diphtheria, tetanus, pertussis) vaccine is the standard of care for routine immunization of young children, not only simplifying the vaccination process but also ensuring broader immunity with fewer injections.

Question 88

Sensory screening like hearing should be performed at what age?
a. Birth
b. 1 month
c. 6 months
d. 12 months

Answer 88

a. Birth
Rationale: Hearing screening is typically performed at birth as part of standard newborn screening procedures to detect early hearing loss and initiate interventions as soon as possible.

Question 89

This age group will show initially crying, either of a tantrum-like, protesting type or a quieter sadder type then subdued withdrawn, irritable, fussy, moody resistant to authority, go out to neighborhood looking for parent, or even leave home as a reaction to separation:
a. Infants
b. Young children
c. School children
d. Adolescents

Answer 89

b. Young children
Rationale: Young children (toddlers to preschool-age) often react to separation with a mix of tantrum-like behavior or sadness, showing signs of distress, and may actively seek the missing parent, consistent with typical reactions in this developmental stage.

Question 90

The first menstrual period in females is usually:
a. Ovulatory and irregular
b. Ovulatory and irregular
c. Anovulatory and regular
d. Anovulatory and irregular

Answer 90

d. Anovulatory and irregular
Rationale: The first menstrual periods in females (menarche) are typically anovulatory and irregular. Ovulation becomes more regular and predictable over time as the hormonal axis matures.

Question 91

You are performing an initial physical examination on a term newborn in the delivery room. The presence of which of the following leads you to suspect an underlying congenital anomaly?*
a. Umbilical hernia
b. Nevus flammeus
c. Single umbilical artery
d. Hypospadias

Answer 91

c. Single umbilical artery
Rationale: The presence of a single umbilical artery (instead of the usual two) is associated with an increased risk of congenital anomalies, particularly affecting the cardiovascular and renal systems.

Question 92

The protein requirements for a full-term infant at birth are:*
a. 2-2.5 g/kg/day
b. 2.5-4 g/kg/day
c. 3-4.5 g/kg/day
d. 4-5 g/kg/day

Answer 92

b. 2.5-4 g/kg/day
Rationale: The protein requirements for a full-term infant at birth are typically between 2.5 and 4 g/kg/day. This range supports rapid growth and development in the early neonatal period.

Question 93

The physical activity of a term normal newborn during examination varies. It is therefore not normal to see:*
a. Coarse, tremulous movements with ankle or jaw myoclonus
b. Absent physical activity during relaxation of normal sleep
c. Asymmetric movement of upper extremities
d. Vigorous crying with accompanying activity of arms and legs

Answer 93

a. Coarse, tremulous movements with ankle or jaw myoclonus
Rationale: Coarse, tremulous movements with myoclonus (involuntary muscle jerks) are not typical for a normal newborn and may suggest neurological disturbances or other complications.

Question 94

The skin of the premature infant is characterized by the following except:*
a. Abundant lanugo over back
b. Crackling, dry, desquamating
c. Deep red, delicate, with visible veins
d. Gelatinous and bruises easily

Answer 94

b. crackling, dry, desquamating.
Premature infants typically have skin that is deep red, delicate, with visible veins, and may be gelatinous and bruise easily; abundant lanugo is also common. However, “crackling, dry, desquamating” skin is not typical but may indicate other skin conditions or environmental factors affecting the skin.

Question 95

On day 3 of a newborn baby, you observe that the skin has small, white, vesiculopustular papules with an erythematous base. Your main consideration would be:*
a. Erythema toxicum
b. Harlequin change
c. Pustular melanosis
d. Scalded skin

Answer 95

a. Erythema toxicum
Rationale: Erythema toxicum is a common benign rash seen in newborns, characterized by small white or yellow papules or pustules on a base of erythema. It typically appears within the first few days of life and resolves without treatment.

Question 96

A 1-day-old infant who was born by a difficult forceps delivery is alert and active. On physical examination, a cephalhematoma on the right temporoparietal area was noted. The following characterizes cephalhematoma except:*
a. It is rounded and discrete, with boundaries limited by suture lines
b. It represents edema of the scalp
c. It may take several weeks to resorb
d. Treatment is not necessary unless there are neurologic indicators

Answer 96

b. It represents edema of the scalp
Rationale: Cephalhematoma is a subperiosteal hemorrhage, not edema, and is confined to the surface of one cranial bone. It is limited by the sutures and often does not manifest any immediate medical concern unless associated with other issues.

Question 97

Which of the following statements is incorrect?*
a. Abnormal vital signs within 30 - 60 minutes of life are always pathologic and indicate an unhealthy newborn
b. Breastmilk is associated with a decreased incidence of several common diseases
c. Circumcision should be routinely recommended based on medical advantage
d. Normal stools from breastfed infants appear to be loose, yellow, and seedy

Answer 97

a. Abnormal vital signs within 30 - 60 minutes of life are always pathologic and indicate an unhealthy newborn
Rationale: Abnormal vital signs within the first hour of life may reflect transitional changes as the newborn adapts to extrauterine life and not necessarily indicate pathology. Continuous monitoring is essential to determine if intervention is needed.

Question 98

The immediate postnatal changes in a term newborn include the following except:*
a. Decrease in pulmonary vascular resistance
b. Decrease in right-to-left shunting via ductus arteriosus
c. Increase in venous return to the left atrium
d. Increase right-to-left shunting via foramen ovale

Answer 98

d. Increase right-to-left shunting via foramen ovale
Rationale: After birth, the foramen ovale typically begins to close as pressure in the left atrium exceeds that in the right, leading to a decrease in right-to-left shunting across the foramen ovale.

Question 99

A normal full-term baby has this posture:*
a. Arms and legs extended
b. Full flexion of arms and legs
c. Slight flexion of hips knees with arms extended
d. Frog-like position of legs

Answer 99

b. Full flexion of arms and legs
Rationale: A normal full-term baby often assumes a posture of full flexion of the arms and legs, reflecting the constrained position in utero.

Question 100

Passage of meconium usually occurs within 12 hr after birth. It is expected that 98% of term babies and 95% of preterm infants have their first stool within:*
a. 24 hr of birth
b. 48 hr of birth
c. 72 hr of birth
d. 96 hr of birth

Answer 100

a. 24 hr of birth.
Rationale: Most newborns pass their first meconium within the first 24 hours of birth. This is a critical period monitored by healthcare providers to ensure there are no signs of gastrointestinal obstruction or other related issues. Delay in the passage of meconium beyond 24 hours can be a sign of potential complications such as intestinal obstruction.